HomeMy WebLinkAbout2658 Declaratio~ ot DomiCile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ' 226442
Si. IUCIE COUNTY, FLORIDA:
This is declarotion of Domicile and Citizenship in the State of Flo~ids that 1 am fili~g this day in aaordance and
in conformity wi hapter 222, Sectian 222.17, Florida Statutes.
I was fo~merly a legal resident of _ _ . _._L_~ -
(Ciy) (State)
and I resided at ~~_~s ~a~~~~d'~~` ~v ~ However 1 have changed my domic,~le
~ (Street a~d Number)
to and am and have been a bona fide tesident of the State of Florida since _~L`~.____L_~~ day of
/ s' ~ -~G~'- 7~~ ~~.,~G
- , 19 and I reside at •~•~~G _ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State of Florida. ~
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
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- ~442
i~. ~o~E .
~T- ~UOIE COIi~
OLERR~CIRCYIT
C~af=NtT
11ECORD YER~FiEO~.....,..,,.
MMt 19 I sz P~!'
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~ 1 FURTHER CHtTIFY that I wilf comply with all other requirements of a leyal resident af thia State.
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I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FIORIDA, permanently.
.S
~ ~ • ~G~~fT~~~-G~-GL'~
~ l7 ~ (Name) ~~~.r~~e.t°J
~ ~.'~•f~N ~ P~ fi .
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.5~4 ZU' ,H-~~G
, . . . ~4~,~,~-(Ad ss '
_ • . _ . . 7~
Sworn to and suburibed before me this ~9 day of E~~ i~ , 197'Z.
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ROGER rO1TRAS
;.g Ci~WT COWtT Notary Pubfic
By a D.C. My Commission expires
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- (To b~ ex~culyd ie duplicat~ and oei~i~al fil~d wiM~ CIKIc Grwit Court, and dupticst~ with Tax Ass~uor.)
F`~
~`j rto i s a BODII ~O PACE~~~
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